Coronary endarterectomy during off-pump coronary artery bypass surgery

Coronary endarterectomy (CEA) is often combined with coronary artery bypass grafting (CABG), which is performed on cardiopulmonary bypass (CPB). Recent advances in off-pump surgical technique and cardioanesthesiology, along with the increasing number of patients with high risk of CPB complications made it possible and desirable to execute CEA on a beating heart. Russian scientific literature lacks reports on these interventions. The study was aimed at evaluation of off-pump CEA feasibility and early outcomes. From 59 patients with ischemic heart disease (IHD), who underwent combined CABG and CEA, off-pump technique was used for 16 (27.1%) patients, including 12 men and 4 women, mean age 55.3 +/- 6.4. All of them had long-lasting history of IHD; 2 patients had angina CCS class II, 12--class III and 2 patents--class IV. Total number of anastomoses was 51 for 16 patients or 3.18 per patient. Open endarterectomy was used in 7 (9%) CEAs, semi-closed--in 9 (11.5%) CEAs. The technique of atherosclerotic plaque extraction, coronary artery reconstruction and bypass was similar in both groups. Complete revascularization was achieved for all patients. At discharge clinical improvement was evident in patients with functional classes 0-1. Diffuse involvement of coronary arteries is not considered to be contraindication for CABG. Simultaneous CEA with off-pump technique helps to achieve complete myocardial revascularization and good early outcomes, comparable with the results of conventional CPB-assisted procedures.